Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders
Open accessAbstract
Objective To examine the use of the aromatase inhibitor letrozole with FSH for ovarian stimulation in poor responders undergoing ovarian superovulation and IUI.Design Observational cohort study as a prospective clinical trial in patients with unexplained infertility and a low response to ovarian stimulation with FSH.Setting Two tertiary referral infertility clinics associated with the Reproductive Sciences Division, University of Toronto.Patient(s) Twelve patients with unexplained infertility undergoing IUI who received FSH alone in 25 prior cycles with poor response (less than three dominant follicles).Intervention(s) Patients were offered letrozole, 2.5 mg/day from day 3-7 of the menstrual cycle with FSH (50-225 IU/day) starting on day 5-7. hCG (10,000 IU) was given when two leading follicles were >/=2 cm followed by IUI.Main outcome measure(s) Number of mature follicles (>1.8 cm), FSH dose, endometrial thickness, and pregnancy rate.Result(s) Improved response to FSH stimulation with letrozole co-treatment was evidenced by the significantly lower FSH dose associated with significantly higher number of mature follicles. During letrozole plus FSH stimulation cycles, clinical pregnancy was achieved in three cycles (21%).Conclusion(s) In this preliminary report, we demonstrate a potential benefit of aromatase inhibition for improving ovarian response to FSH in poor responders.
AI snapshot
Written from the paper’s full text.
TL;DR
In 12 poor responders with unexplained infertility, adding letrozole to FSH improved ovarian response compared with prior FSH-only cycles. Letrozole plus FSH produced more mature follicles, required less FSH, and yielded three clinical pregnancies (21%), with no pregnancies in FSH-only cycles.
Key findings
- Letrozole plus FSH cycles had significantly more mature follicles (>1.8 cm) than FSH-only cycles: 3.3 ± 1.8 vs 1.9 ± 0.6 (P = .003).
- Total FSH per cycle was significantly lower with letrozole plus FSH: 616 ± 454 IU vs 1590 ± 708 IU (P = .0001), and stimulation days were fewer: 6.57 ± 1.95 vs 9 ± 3.42 (P = .026).
- E2 per mature follicle on hCG day was significantly lower with letrozole plus FSH: 626 ± 302 pmol/L vs 1324 ± 485 pmol/L (P = .0001), while E2 on hCG day, endometrial thickness, and LH on hCG day were not significantly different.
- No pregnancies occurred in FSH-only cycles; during letrozole plus FSH cycles, four patients achieved pregnancy, including three clinical pregnancies (21%) and one chemical pregnancy.
Methods
- Observational cohort study conducted as a prospective clinical trial in 12 patients with unexplained infertility and poor response to FSH in at least two prior cycles, defined as fewer than three follicles >1.8 cm on the day of LH surge or hCG administration.
- Patients received FSH alone in 25 prior cycles and letrozole 2.5 mg/day from day 3–7 plus FSH 50–225 IU/day in 14 cycles; hCG 10,000 IU was given when two leading follicles reached >2 cm, followed by IUI.
- Outcomes were compared between 20 completed FSH-only cycles (excluding canceled cycles) and 14 letrozole plus FSH cycles using t-tests with GraphPad Prism Version 3.
Limitations
- The paper states this preliminary report includes a small number of patients and used a nonrandomized, nonplacebo-controlled design.
- The paper states that possible effects of a short course of letrozole on pregnancy outcome are unknown and should be addressed in counseling and pregnancy follow-up.
- The text makes evident that the comparison relies on prior FSH-only cycles rather than concurrent randomized controls, and that five canceled FSH-only cycles were excluded from the outcome comparison.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
Statistics
Claims the paper makes
0 of 15 cited sources checked · 0 supported · 0 flagged
- Findingown data
In poor responders, letrozole co-treatment with FSH resulted in a significantly lower E2 level per mature follicle on the day of hCG administration than FSH-only stimulation.
“Although there was no difference in the level of E 2 on the day of hCG administration, the amount of E per mature follicle was significantly lower with letrozole treatment.”
- Also stated in: § DISCUSSION · plain
“E2/mature follicle on hCG day (pmol/L) 1324 Ϯ 485 626 Ϯ 302 .0001”
- Also stated in: § DISCUSSION · plain
“Letrozole treatment was associated with a significantly lower amount of E per mature follicle but still within phys-iologic levels seen during natural cycles.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In poor responders, letrozole co-treatment with FSH resulted in significantly fewer stimulation days per cycle than FSH-only stimulation.
“Stimulation days/cycle 9 Ϯ 3.42 6.57Ϯ 1.95 .026”
Quote in the paperSubstantial claim - Findingown data
Preliminary data from the authors show increased FSH and LH during letrozole treatment.
“We have preliminary data to support this mechanism of action in the form of increased FSH and LH during letrozole treatment (data not shown).”
Quote in the paperSubstantial claim - Findingown data
In poor responders, there was no significant difference in the day of hCG administration between letrozole+FSH and FSH-only cycles.
“There was no significant difference between FSH-only or letrozole plus FSH on the day of hCG administration, LH level, or endometrial thickness on the day of hCG administration”
- Also stated in: § DISCUSSION · plain
“Day of hCG administration 11.6 Ϯ 2.27 11.78 Ϯ 0.939 NS”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In poor responders, clinical pregnancy was achieved in three letrozole+FSH cycles (21%).
“During letrozole plus FSH stimulation cycles, clinical pregnancy was achieved in three cycles (21%).”
- Also stated in: § RESULTS · plain
“Three had clinical pregnancies (21%) and one had a chemical pregnancy.”
- Also stated in: § DISCUSSION · plain
“In addition, three clinical pregnancies were achieved in the letrozole and FSH cycles.”
Quote in the paperSubstantial claim - Also stated in: § RESULTS · plain
- Findingown data
In poor responders, letrozole co-treatment with FSH resulted in a significantly higher number of mature follicles (>1.8 cm) than FSH-only stimulation.
“significantly higher number of mature follicles.”
- Also stated in: § RESULTS · plain
“During FSH plus letrozole stimulation cycles, the mean number of mature follicles was 3.3, which was significantly higher than in the FSH-only stimulation cycles (1.9 follicles).”
- Also stated in: § DISCUSSION · plain
“No. of mature follicles (Ͼ1.8 cm) 1.9 Ϯ 0.6 3.3 Ϯ 1.8 .003”
Quote in the paperSubstantial claim - Also stated in: § RESULTS · plain
- Findingown data
In poor responders, four patients achieved pregnancy during letrozole+FSH treatment cycles.
“whereas four patients achieved pregnancy during letrozole plus FSH treatment cycles.”
Quote in the paperSubstantial claim - Findingown data
In poor responders, there was no significant difference in E2 level on the day of hCG administration between letrozole+FSH and FSH-only cycles.
“Although there was no difference in the level of E 2 on the day of hCG administration”
- Also stated in: § DISCUSSION · plain
“E2 on hCG day (pmol/L) 2471 Ϯ 1113 1786 Ϯ 898 NS”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In poor responders, there was no significant difference in endometrial thickness on the day of hCG administration between letrozole+FSH and FSH-only cycles.
“There was no significant difference between FSH-only or letrozole plus FSH on the day of hCG administration, LH level, or endometrial thickness on the day of hCG administration indicating the absence of any antiestrogenic effects of letrozole on the endometrium.”
- Also stated in: § DISCUSSION · plain
“Endometrial thickness on hCG day (cm) 0.89 Ϯ 0.1 0.88 Ϯ 0.09 NS”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In poor responders with unexplained infertility, letrozole co-treatment with FSH resulted in a significantly lower total FSH dose per cycle than FSH-only stimulation.
“Improved response to FSH stimulation with letrozole co-treatment was evidenced by the significantly lower FSH dose associated with significantly higher number of mature follicles.”
- Also stated in: § RESULTS · plain
“The amount of FSH required was significantly lower in the letrozole plus FSH cycles than the FSH-only cycles.”
Quote in the paperSubstantial claim - Also stated in: § RESULTS · plain
- Findingown data
In poor responders, there was no significant difference in LH level on the day of hCG administration between letrozole+FSH and FSH-only cycles.
“There was no significant difference between FSH-only or letrozole plus FSH on the day of hCG administration, LH level, or endometrial thickness on the day of hCG administration indicating the absence of any antiestrogenic effects of letrozole on the endometrium.”
- Also stated in: § DISCUSSION · plain
“LH on hCG day (IU/L) 10.3 Ϯ 4.3 16.7 Ϯ 13.7 NS”
Quote in the paperNot a substantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
In poor responders, no pregnancy occurred during FSH-only stimulation cycles.
“There was no pregnancy during the FSH alone stimulation cycles”
Quote in the paperSubstantial claim - Interpretationown data
Letrozole co-treatment improves ovarian response to FSH in poor responders.
“In this preliminary report, we demonstrate a potential benefit of aromatase inhibition for improving ovarian response to FSH in poor responders.”
- Also stated in: § DISCUSSION · boosted
“In this observational cohort clinical trial, we demonstrate a potential benefit of aromatase inhibition by letrozole in improving ovarian response to FSH stimulation in poor responders.”
Quote in the paperSubstantial claim- Rests on an assumption: The prior FSH-only cycles and the letrozole+FSH cycles are comparable enough that the observed differences in ovarian response can be attributed to letrozole.
- Rests on an assumption: Multiple follicle development during gonadotropin stimulation correlates positively with pregnancy outcome.
- Also stated in: § DISCUSSION · boosted
- Interpretationreasoning
The relatively brief half-life of letrozole (45 hours) should allow rapid disappearance of the drug before the critical period of embryogenesis, likely even before implantation.
“However, the relatively brief half-life of letrozole (45 hours) and other nonsteroidal aromatase inhibitors should allow the rapid disappearance of the drug long before the critical period of embryogenesis, more likely even before implantation.”
Quote in the paperNot a substantial claim - Interpretationcitation
Lowering E2 in controlled ovarian hyperstimulation cycles may be beneficial in avoiding possible drawbacks of supraphysiologic E levels.
“Lowering E 2 in COH cycles may be beneficial in avoiding the possible drawbacks of the supraphysiologic levels of E associated with ovarian superovulation.”
Quote in the paperSubstantial claim - Interpretationreasoning
Letrozole's central action likely mimics clomiphene citrate's mechanism but without estrogen receptor depletion.
“This central action likely mimics the mechanism of action of CC, but with the major advantage of no E receptor depletion as seen with an E antagonist.”
Quote in the paperSubstantial claim - Premisecitation
When letrozole was used with FSH, a significant reduction occurred in the FSH dose needed for controlled ovarian hyperstimulation.
“Moreover, we have shown that when letrozole was used with FSH, a significant reduction occurred in FSH dose needed for controlled ovarian hyperstimulation (15,16).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [15] Mitwally, 2000, The aromatase inhibitor, letrozole, decreases FSH dose required for ovarian superovulation
Not checked in the free run.
- cites [16] Mitwally, 2001, Aromatase inhibition decreases FSH dose needed during controlled ovarian hyperstimulation: a controlled prospective trial
Not checked in the free run.
- Interpretationown data
Letrozole treatment has no antiestrogenic effects on the endometrium in poor responders undergoing ovarian stimulation.
“indicating the absence of any antiestrogenic effects of letrozole on the endometrium.”
Quote in the paperSubstantial claim- Rests on an assumption: Endometrial thickness on the day of hCG administration is a valid marker of antiestrogenic effects of letrozole on the endometrium.
- Interpretationown data
Letrozole may act centrally by reducing estrogen production in the hypothalamus and pituitary, thereby enhancing gonadotropin secretion by releasing negative feedback.
“We believe that blockade of E synthesis by an aromatase inhibitor in the early part of the menstrual cycle will decrease E negative feedback centrally, resulting in increased gonadotropin secretion.”
- Also stated in: § DISCUSSION · hedged
“Centrally, aromatase inhibition, by reducing E production to postmenopausal levels in the hypothalamus and pituitary, may enhance gonadotropin secretion by releasing negative feedback of E.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · hedged
- Study design and conductown data
Five FSH-only cycles were discontinued because of inadequate response.
“Five cycles were discontinued because of inadequate response (FSH injection was stopped around day 9 of the cycle and follicular monitoring discontinued when only one follicle was found to be growing).”
Quote in the paperNot a substantial claim - Premisecitation
Testosterone augments follicular FSH receptor expression in primates.
“Testosterone was found to augment follicular FSH receptor expression in primates suggesting that follicular growth may be improved by amplification of FSH effects (18 -20).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [18] Weil, 1999, Androgen and follicle-stimulating hormone interactions in primate ovarian follicle development, J Clin Endocrinol Metab source
Not checked in the free run.
- cites [19] Vendola, 1999, Androgens promote oocyte insulin-like growth factor I expression and initiation of follicle development in the primate ovary, Biol Reprod source
Not checked in the free run.
- cites [20] Vendola, 1998, Androgens stimulate early stages of follicular growth in the primate ovary, J Clin Invest source
Not checked in the free run.
- Premisecitation
Androgens stimulate early follicular growth in primates.
“Recent data support a stimulatory role for androgens in early follicular growth in primates (17).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Weil, 1998, Androgen receptor gene expression in the primate ovary, J Clin Endocrinol Metab source
Not checked in the free run.
- Interpretationown data
The lower E2 per mature follicle with letrozole treatment remained within physiologic levels seen during natural cycles.
“Letrozole treatment was associated with a significantly lower amount of E per mature follicle but still within phys-iologic levels seen during natural cycles.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 3
- May combine two claims. 4
Classified as probably not a substantial claim.
PremisecitationAndrogen accumulation in the follicle may stimulate insulin-like growth factor I and other endocrine and paracrine factors that may synergize with FSH to promote folliculogenesis.
“In addition, androgen accumulation in the follicle may stimulate insulin-like growth factor I (IGF-I), and other endocrine and paracrine factors, which may synergize with FSH to promote folliculogenesis (29 -31).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [29] Adashi, 1993, Intraovarian regulation, Ann NY Acad Sci source
Not checked in the free run.
- cites [30] Giudice, 1992, Insulin-like growth factors and ovarian follicular development, Endocr Rev
Not checked in the free run.
- cites [31] Yen, 1993, Interface between extra- and intra-ovarian factors in polycystic ovary syndrome (PCOS), Ann NY Acad Sci source
Not checked in the free run.
May combine two claims.
PremisecitationMarkedly elevated E levels have deleterious effects on the embryo or endometrium and jeopardize the chance of achieving pregnancy.
“Markedly elevated E levels have been reported to have deleterious effects on the embryo or the endometrium and jeopardize the chance of achieving pregnancy (32,33).”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationLetrozole induces ovulation in anovulatory women with polycystic ovary syndrome and augments ovulation in ovulatory women.
“We have reported the success of aromatase inhibition by letrozole in inducing ovulation in anovulatory women with polycystic ovary syndrome (PCOS) (11)(12)(13)(14) and augmenting ovulation in ovulatory women (13,14).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [11] Mitwally, 2000, The use of an aromatase inhibitor for induction of ovulation in cases of clomiphene citrate failure
Not checked in the free run.
- cites [12] Mitwally, 2000, Aromatase inhibition, Reprod Technol
Not checked in the free run.
- cites [13] Mitwally, 2000, The aromatase inhibitor, letrozole: a promising alternative for clomiphene citrate for induction of ovulation
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationAromatase is a cytochrome P-450 enzyme complex that catalyzes the rate-limiting step in estrogen production.
“Aromatase is a cytochrome P-450 enzyme complex that catalyzes the rate-limiting step in the production of estrogens (E), that is, the conversion of the androgens, androstenedione and testosterone, to estrone (E 1 ) and E 2 (9).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Akhtar, 1993, Mechanistic studies on aromatase and related C-C bond cleaving P-450 enzymes, J Steroid Biochem Mol Biol source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductown dataThe study was a preliminary clinical report with a small number of patients treated in a nonrandomized, nonplacebo controlled design.
“This preliminary clinical report includes a small number of patients treated in a nonrandomized, nonplacebo controlled design.”
Quote in the paperSubstantial claim
The paper relies on this without support.
The prior FSH-only cycles and the letrozole+FSH cycles are comparable enough that the observed differences in ovarian response can be attributed to letrozole.
“This preliminary clinical report includes a small number of patients treated in a nonrandomized, nonplacebo controlled design.”
The paper relies on this without support.
Multiple follicle development during gonadotropin stimulation correlates positively with pregnancy outcome.
“Achievement of multiple follicle development during gonadotropin stimulation has been found to correlate positively with the outcome of infertility management in terms of achievement of pregnancy.”
The paper relies on this without support.
Endometrial thickness on the day of hCG administration is a valid marker of antiestrogenic effects of letrozole on the endometrium.
“There was no significant difference between FSH-only or letrozole plus FSH on the day of hCG administration, LH level, or endometrial thickness on the day of hCG administration indicating the absence of any antiestrogenic effects of letrozole on the endometrium.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Letrozole can successfully replace clomiphene citrate in superovulation treatment of patients with unexplained infertility or polycystic ovarian disease and in poor responders.
“Recently, it was suggested that letrozole, a specific reversible, nonsteroidal aromatase inhibitor that suppresses estrogen biosynthesis (16), can successfully replace clomiphene citrate in superovulation treatment of patients with unexplained infertility or polycystic ovarian disease and in poor responders (17,18).”
From Effects of letrozole on superovulation with gonadotropins in women undergoing intrauterine insemination (2003) · cites this paper as [18]
Letrozole improves ovarian response to follicle-stimulating hormone in poor responder women.
“This is in agreement with the previous report (19) that letrozole improves ovarian response to FSH in poor responder women.”
From A randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation (2004) · cites this paper as [19]
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Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation
Mitwally, M. F., & Casper, R. F. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03975-4 · Cited by 178 · see citing works
Self-citationA randomized trial of letrozole versus clomiphene citrate in women undergoing superovulation
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Badawy, A., Aal, I. A., & Abulatta, M. (2007) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.02.062 · Cited by 133 · see citing works
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Aromatase inhibitors for the treatment of infertility
Mitwally, M. F., & Casper, R. F. (2003) · Expert Opinion on Investigational Drugs · doi:10.1517/13543784.12.3.353 · Cited by 120 · see citing works
Self-citationAndrogens and ovarian function: translation from basic discovery research to clinical impact
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Begum, M. R., Ferdous, J., Begum, A., & Quadir, E. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.08.044 · Cited by 109 · see citing works
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Badawy, A., Mosbah, A., & Shady, M. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.05.010 · Cited by 76 · see citing works
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Mukherjee, A. G., Wanjari, U. R., Nagarajan, D., Vibhaa, K. K., Anagha, V., Joshua Paul, P., Thirumoorthy, T. P., Chakraborty, R., Renu, K., Dey, A., et al. (2022) · Life Sciences · doi:10.1016/j.lfs.2022.121074 · Cited by 76 · see citing works
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Biomaterials for Dental Implants: An Overview
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Poor responder protocols for in-vitro fertilization: options and results
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Aromatase inhibitors: possible future applications
Karaer, Ö., Oruç, S., & Koyuncu, F. M. (2004) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.0001-6349.2004.00562.x · Cited by 59 · see citing works
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Polycystic ovaries and infertility: Our experience
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Gat, I., Mejía, S. B., Bałakier, H., Librach, C. L., Claessens, A., & Ryan, E. (2016) · Gynecological Endocrinology · doi:10.3109/09513590.2015.1137095 · Cited by 46 · see citing works
The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment
Giannelou, P., Simopoulou, M., Grigoriadis, S., Makrakis, E., Kontogeorgi, A., Pantou, A., Galatis, D. G., Kalampokas, T., Bakas, P., Bolaris, S., et al. (2020) · Diagnostics · doi:10.3390/diagnostics10090687 · Cited by 45 · see citing works
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Kedem, A., Tsur, A., Haas, J., Yerushalmi, G., Hourvitz, A., Machtinger, R., & Orvieto, R. (2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.02.036 · Cited by 43 · see citing works
Aromatase inhibitors for ovulation induction and ovarian stimulation
Lee, V. C. Y., & Ledger, W. J. (2011) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04006.x · Cited by 42 · see citing works
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Youssef, M. A. F. M., van Wely, M., Mochtar, M. H., Fouda, U. M., ElDaly, A. A., Abidin, E. Z. E., Elhalwagy, A., Abdallah, A. A. M., Zaki, S. S., Ghafar, M. S. A., et al. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2017.10.033 · Cited by 42 · see citing works
Different ovarian stimulation protocols for women with diminished ovarian reserve
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Self-citationMisoprostol With or Without Letrozole Pretreatment for Termination of Pregnancy
Lee, V. C. Y., Ng, E. H. Y., Yeung, W. S. B., & Ho, P. C. (2011) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3182073fbf · Cited by 41 · see citing works
Haas, J., Bassil, R., Meriano, J., Samara, N., Barzilay, E., Gonen, N., & Casper, R. F. (2017) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-017-0288-8 · Cited by 38 · see citing works
Self-citationEruption Chronology in Children: A Cross-sectional Study
Verma, N., Bansal, A. V., Tyagi, P., Jain, A., Tiwari, U., & Gupta, R. (2017) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-1450 · Cited by 40 · see citing works
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Managing and Predicting Low Response to Standard In Vitro Fertilization Therapy
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Potential of Aromatase Inhibitors for Ovulation and Superovulation Induction in Infertile Women
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Self-citationTechniques for fertility preservation in patients with breast cancer
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Evolution of External and Internal Implant to Abutment Connection
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Self-citation
- Authors
- Mitwally, M. F. M., & Casper, R. F.
- Affiliations
- Mount Sinai Hospital (CA)
- Corresponding author
- Casper, Robert F
- ORCID
- Casper, Robert F
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2002-04
- Volume
- 77
- Issue
- 4
- Pages
- 776-780
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2023963334
- Semantic Scholar
- c28960882fbca4247ecf3e0ab20c305b14652355
- Cited by
- 407
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 36 · 2016: 11 · 2015: 42 · 2014: 45 · 2013: 30 · 2012: 41
- FWCI
- 13.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Keywords
- aromatase inhibitors, letrozole, poor ovarian responders, follicle-stimulating hormone, ovulation induction, superovulation, intrauterine insemination, unexplained infertility, clinical pregnancy rate
- MeSH terms
- Letrozole, Endometrium, Enzyme Inhibitors, Estradiol, Female, Follicle Stimulating Hormone, Chorionic Gonadotropin, Ovarian Follicle, Humans, Insemination, Artificial, Menstrual Cycle, Nitriles, Ovulation Induction, Pregnancy, Prospective Studies, Triazoles, Cohort Studies, Aromatase Inhibitors
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